Transcription
[Music] A common question that we get from patients or potential patients is regarding heel bursitis.
Now, when you hear bursitis, what that means is basically swelling of these small fluid-filled sacs that we have around all of our joints that are there to decrease friction between tissue and bone.
So, if we look behind me on this picture, here's a foot and then here's our heel. This is our Achilles tendon, which connects our heel and then up to our calf muscles. You have a small bursa back here called a retrocalcaneal bursa. Basically, like I said, it should just kind of decrease any friction between the Achilles tendon and your heel bone.
When this bursa gets inflamed and swollen, it can be very, very painful, and that's when people develop what's called heel bursitis. Now, there are two different types: there's acute bursitis and chronic bursitis.
Acute bursitis, especially of this retrocalcaneal bursa, could be that all of a sudden, you throw yourself into a crazy workout regimen that you haven't done before, and you might irritate that bursa and it gets inflamed. You rest, and it gets better.
When people have what we call chronic bursitis or they've had this chronic heel pain, they've been diagnosed with bursitis but they've rested, they've maybe even iced it, taken anti-inflammatories, and it's not getting better, those are cases that need to be evaluated for a secondary cause.
In the case of this bursa, a lot of times it's related to any kind of chronic injury of this Achilles tendon. Oftentimes in these cases, when people come to the office, we do an ultrasound exam of the Achilles tendon, and a lot of times we'll find that there are injuries there as well as the presence of this bursitis.
Maybe they have an Achilles tear or tendinopathy, which is tendon degeneration and just chronic tissue damage to that Achilles. In those cases, we will actually treat the Achilles tendon with prolotherapy or PRP, which is platelet-rich plasma, to work to regenerate this whole tendon and grow new healthy tissue so that this bursa actually no longer has to swell.
One of the reasons why this bursa will swell from Achilles tendon damage is that as you get tendinopathy, which we said was tendon degeneration, your Achilles tendon will actually get bigger. It's almost counterintuitive; you would think if a structure is degenerating, it might shrivel up. But what happens is the tendon gets bigger, it takes up more room, and then pushes and irritates that bursa.
So, if you were getting cortisone shots or doing everything you could to decrease the inflammation of that bursa, but that thick tendon just keeps hitting on it, those therapies are going to fail. The only way to get that chronic bursitis to resolve in the presence of an Achilles tendon injury is to heal the injuries of that tendon.